Does Medicare cover dentures?

More than three-quarters of Medicare Advantage enrollees in dental plans that provided extensive dental services had coverage for periodontics and/or prosthodontics, according to KFF’s most recent study of Medicare Advantage dental benefits in 2021. Periodontics is the prevention and treatment of gum and tooth diseases. Prosthodontics is dentistry that specializes in making replacements for missing or damaged teeth; including dentures, dental bridges, implants and other false teeth.

Typically, plans that cover dentures limit coverage to one set every five years. But coverage details and out-of-pocket costs vary widely. In the 2021 KFF study, plans covering dentures charged a fixed-dollar copayment ranging from $0 to $500 or coinsurance rates of 50 to 70 percent of the cost for in-network providers.

Most plans annually cap extensive dental services, averaging $1,300, according to the KFF study, but 8 percent of the plans had a coverage cap of $2,000 to $5,000. This cap usually didn’t apply to routine and preventive dental care.

Where can I find what Medicare Advantage covers?

You can find information about dental coverage for each Medicare Advantage plan in your area in the Medicare Plan Finder. Key in your zip code, select Medicare Advantage and answer a few questions. You’ll see a list of your area’s Medicare Advantage plans. A green check mark notes ✓ Dental in the Plan Benefits list. You can narrow the list by clicking on Filter by: Plan Benefits, checking the box beside Dental coverage and clicking Apply. 

For general information about the plan’s denture coverage, click Plan Details and scroll down to Extra Benefits. Look for the Prosthodontics section under Comprehensive Dental to find out whether the plan covers dentures and other dental prosthetics and in-network and out-of-network copays. You’ll see a note if you need prior approval and are subject to plan limits.

You can find more coverage details in the plan’s summary of benefits or evidence of coverage on the company’s website, which you can find by clicking on the link by the plan name in the Plan Finder.

How else can I get help paying for dentures?

Other sources can help defray the costs of dentures.

• Dental discount programs. Some programs charge an up-front annual fee in return for discounts on dental services, ranging from 30 percent to 40 percent off on cleanings, crowns, exams and fillings. They may offer a 15 percent to 50 percent discount on the cost of dentures. These programs sometimes require you to use certain dentists. 

• Extra coverage from Medigap. Though standard Medigap policies don’t provide dental coverage, some Medigap insurers allow you to add dental coverage or membership in a dental discount program for an extra premium.

• Medicaid. The joint federal-state program provides dental coverage for adults who meet income requirements in some states. More than half the states provide some coverage for dentures, but they may be subject to prior authorization requirements or limited to one pair every five or six years. Contact your state Medicaid office for details.

• Standalone dental insurance policies. Premiums, copayments, covered services, waiting periods, network requirements and annual coverage maximums vary from plan to plan. Some plans cover dentures, typically with a 50 percent copayment.

• Veterans benefits. The U.S. Department of Veterans Affairs provides dental care, including dentures, to certain qualified veterans. Learn more on the VA’s dental care page.

Keep in mind

You can withdraw money tax-free from a health savings account (HSA) to pay most out-of-pocket dental expenses. You can’t contribute to an HSA after you enroll in Medicare, but you can use money you’ve already saved in the account for eligible medical expenses, including dentures and many dental expenses that insurance doesn’t cover, at any age.